胰腺疾病(英文)课件.ppt

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1、胰腺疾病解剖生理概要解剖头，颈，体，尾，钩突。主胰管(ductofWirsung)副胰管(ductofSantorini)胰腺分泌外分泌Exocrine内分泌EndocrineB,A,D,D1,GcellcCausesGallstones:60%(35–50%inUSA)Alcohol:14%%(60%inUSA)Duodenaljuicecountercurrentflow:SphincterofOddidysfunctionTraumaPancreascirculationdisorderOtherfactors:Drug:Azathioprine(硫唑嘌呤).6-Mercaptop

2、urine(6-巯基嘌呤),Pancreasdivisum(胰分裂),MicrolithiasisMetaboliccauseInfectiouscauses,ascarisworms蛔虫,HIV-----Miscellaneous急性胰腺炎Pathologyacuteedematouspancreatitisacutehemorrhagicnecrotizingpancreatitis(acutehemorrhagicpancreatitis,acutenecrotizingpancreatitis)急性胰腺炎PathophysiologyHypersecretionandobstru

3、ctionSelf-enzymaticdigestionEnhancementofVesselpermibilityCytokine，infectionDecreasedarterialperfusionEdematoushemorrhagicnecrotizing急性胰腺炎ClinicalfindingAbdominalpainAbdominaldistentionNauseaandvomitingPeritonitisOther:Respiratoryfailure,confusion,orcoma.Low-gradetomoderatefeverTachycardiaandhypo

4、tensionandShockMildjaundice,Pleuraleffusion.急性胰腺炎急性胰腺炎Peritonealirritationsign（Abdominaltenderness，reboundtendernessandrigidity）ShiftingdullnessDecreasedbowelsoundsCullen’sign:discolorationofperiumbilicalareaGreyTurner’sign:discolorationofflanksLaboratoryfindingAmylaseandlipase(elevationsofamylas

5、earemoresensitivebutlessspecificthanlipaseinthediagnosisofacutepancreatitis)500400300200100001H24H48H5DAY急性胰腺炎BloodamylaseUrineamylase急性胰腺炎SerumcalciumSerumglucoseBloodgasanalysisImunolipaseALTandAST(gallstonepancreatitis)ImagingfindingX-rayDilatedloopofsmallbowel(sentinelloop)Abruptcessationofga

6、sinthedistaltransversecolon(coloncutoffsign)Radioopaquedensities(biliarycalculi)Left-sidedpleuraleffusionB-US:pancreaticedema,ascites----CT:Important急性胰腺炎•CTisthebestdiagnostictestforthediagnosisofacutepancreatitis.•Contrast-enhancedCTisexcellentfordiagnosisofpancreaticnecrosis有力武器急性胰腺炎Assessment

7、ofseverityofacutepancreatitisRanson'scriteriaOnAdmissionWithin48HoursAge>55yearsHematocritdecreaseby>10%WBC>16,000/mm³Ureanitrogenincrease>5mg/dlLDH>350IU/LSerumcalcium<1.87mmol/lGlucose>11.1mmol/lArterialPO²<8KPa(60mm